Provider Demographics
NPI:1134306996
Name:THOMAS A. HANSCOM, MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS A. HANSCOM, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-829-3303
Mailing Address - Street 1:2021 SANTA MONICA BLVD STE 720E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2223
Mailing Address - Country:US
Mailing Address - Phone:310-829-3303
Mailing Address - Fax:
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 720E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2223
Practice Address - Country:US
Practice Address - Phone:310-829-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty